title: Mood disorders after traumatic brain injury in adolescents and young adults: a nationwide population-based cohort study.
abstract: OBJECTIVE
  To delineate the relationship between traumatic brain injury (TBI) and mood disorders from population-based data in Taiwan.
  
  
  METHODS
  This prospectively followed cohort study involved a subset of the National Health Insurance Research Database containing complete inpatient and outpatient data of 1 million randomly drawn beneficiaries. We included 10- to 24-year-old patients (n = 15,203) receiving the diagnosis of TBI in ambulatory visits or hospitalization from 2000-2004 and their age- and sex-matched comparison insureds using health service in the same year (n = 76,015). Diagnosis of mood disorders was recorded within 5 years after the traumatic event or index use of health service. Baseline demographics, clinical characteristics, and premorbid psychiatric conditions were compared using χ(2) analysis. Increased risk during the 5-year follow-up period was represented by crude and adjusted hazard ratios with 95% CI using a Cox proportional hazard regression.
  
  
  RESULTS
  A total of 451/15,203 patients with TBI (2.97%) received a diagnosis of mood disorders in the 5-year follow-up period compared with 1153/97,445 individuals (1.52%) without antecedent TBI. After adjusting for select premorbid comorbidities, TBI remained a significant predisposing factor with a 1.96-fold (95% CI 1.74-2.22) increase in risk of mood disorders.
  
  
  CONCLUSIONS
  Our findings show a higher likelihood of manifesting mood disorders in adolescents and young adults who sustained a prior TBI. Health professionals should carefully monitor both the physical and psychological impacts of head trauma.
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Meng-Che
authors.initials: MC
authors.lastname: Tsai
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Kuen-Jer
authors.initials: KJ
authors.lastname: Tsai
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Hao-Kuang
authors.initials: HK
authors.lastname: Wang
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Pi-Shan
authors.initials: PS
authors.lastname: Sung
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Ming-Hsiu
authors.initials: MH
authors.lastname: Wu
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, Yuan's General Hospital, Kaohsiung, Taiwan.
authors.forename: Kuo-Wei
authors.initials: KW
authors.lastname: Hung
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: shlin922@mail.ncku.edu.tw.
authors.forename: Sheng-Hsiang
authors.initials: SH
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology* / Q000209:etiology; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: EC; Enrollee category; HR; Hazard ratio; ICD-9-CM; International Classification of Diseases, Ninth Revision, Clinically Modified; NHI; National Health Insurance; TBI; Traumatic brain injury